Kate Dimond Fitzgerald, M.D.

Getting the Picture

Using functional MRI to craft better OCD treatments

issue 2 | Fall 2012

University of Michigan researchers are working to improve the treatment of children with obsessive compulsive disorder (OCD), a common anxiety disorder that affects approximately 3 percent of children and adolescents. OCD is characterized by intrusive, distressing thoughts (the obsessions) that lead to performing "neutralizing" behaviors (the compulsions). Obsessions and compulsions tend to occur around certain topics, including contamination/cleaning, safety/checking and symmetry/ordering, and can interfere with schoolwork, friendships and family functioning.

While OCD can be very disabling, it is treatable with specific psychotherapy techniques and medications. Kate Fitzgerald, M.D., child psychiatrist at the University of Michigan, is using functional MRI to understand the brain basis of psychotherapeutic methods to help these children.

"At its core, we think OCD is a hypersensitivity to making mistakes, particularly in key 'security concern' domains such as checking that doors are locked at night to make sure our family is safe," explains Fitzgerald. "From an evolutionary standpoint, these areas of concern are important for all human beings to stay safe and feel secure. So, all of us may be more sensitive to making mistakes in security concern domains, but in patients with OCD, a general hypersensitivity to errors may turn into obsessions and compulsions once security concerns have been tapped."

Children with OCD show hyperactivity in the anterior cingulate cortex when they monitor performance to detect mistakes

"This is the core process — hypersensitivity to making mistakes — that we look at with the fMRI," continues Fitzgerald. "Kids with OCD have an exaggerated response in their anterior cingulate cortex when they make even a simple cognitive error. The more hyper the response is, the lower their symptoms are, suggesting that this hyperactivity may somehow be compensating to push down symptoms."

Fitzgerald is studying exposure/response prevention psychotherapy treatment in conjunction with the fMRI scans. "We are predicting that this hyperactivity in the brain is going to further increase with effective treatment," she explains. "We'll compare the fMRI before and after therapy, so we can assess how improvement in symptoms maps into changes in the brain. In the long run, determining the brain changes that occur with effective treatment will help us customize better treatments for individual children with OCD."

With funding from the National Institute of Mental Health and the Dana Foundation, Dr. Fitzgerald studies the relationship between brain development and anxiety in youth, particularly obsessive compulsive disorder.